Name
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First Name
Last Name
Phone
*
(###)
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
Date of Birth
MM
DD
YYYY
Marital Status
Emergency Contact
First Name
Last Name
Emergency Contact relation to you
Emergency Contact phone number
(###)
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Education, training, background that would be helpful in volunteering with BYB
Please briefly describe your faith testimony and include, if applicable, church membership, training or certification, and any other information you feel would be applicable to your volunteering at BYB.
Are you a member of a church? If so, which one?
Why do you want to volunteer with BYB?
Please identify your skillsets and interests.
Culinary arts
Administrative work / Clerical
Technology / media
Grant writing
Carpentry / handyman / plumbing / etc
Lawn / gardening
Arts / crafts / painting
Fundraising
Errand running
Hosting patient families when they visit
Housekeeping
Grocery hopping
Retreats
Counseling
Nursing
Teaching
Massage therapy
Aesthetician/esthetician services
Cosmetology services
Odd jobs
Organization projects
Card writing
Other
If you checked "Other" above, or wish to further clarify any interest, please describe.
Although we realize this may need to be adjusted over time, please indicate the days and times that you are most likely available to serve.
Do you have any physical limitations that would limit the services you're able to provide?
I have read and agreed to the terms of the Waiver and Release (below).
I have read and agreed to the terms of the Media Release (below).
I have read and agreed to the terms of the Confidentiality Statement (below).
I attest that to the best of my knowledge, the above information is true. I will email my release forms to info@chariscare.com, and I will complete my background screening check.
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